LACC Request for Employee Network/Email Account

Request for Employee Network/Email Account PLEASE COMPLETE THIS FORM ON LINE,then return it to IT (AD 107) with a copy of the PCR work assignment. Incomplete/Ineligible data will delay the request.

Control Number: E-250339
Printed: Monday, 5/20/2013
Received by: _____, / /

Requested for: ,
(As in LACCD records)                        Last Name                                               First Name                                    M. Initial(If any,required)
Empl #:    Dept:    Building & Office:
Title:           LACCD Class code:
Acct. Type:   Administrator      Classified    Certificated          Unclassified
                    Student assistant Contractor with Other:
Assignment: Full time              Part time
Status:           Current Empl.      New Hire Returning Empl. Not a LACCD Empl.
Add. info:      Current assignment ends on
                     Reactivate account.
                     Transfered from another college within LACCD:
Voice mail:    Will use voice mail on ext. (1 ext with 1 user's voice mail)
      ?             Add to voice menu on shared ext. (1 ext w/several voice mails)
                     Need voice mail on new ext. # and phone (New full-time LACC position only).
                     No voice mail needed. Display ext. on Employee Phone directory.
Multiline phones; the extensions below should ring on line:
      ?              1     2     3     4     5     6
Comments: ------------------------------------------------------------------------------------------------- Requested by: ,
(Dept. Chair/Supervisor)         Last Name                                         First Name                                  Department                        Ext.

Employee is no longer working at LACC. Disable all his/her accounts.

Requested-by signature: __________________________    Date: ====== S t o p - - - D o n o t w r i t e b e l o w t h i s l i n e - - - R e t u r n f o r m t o I T ======

IT Manager approval: Signature: __________________________ Date: ___________ Manager's instructions: ___________________________________________________________ IT Work Done: Initials: _____ Date: ________ Initials: _____ Date: ________
DEC Usename: _____________ DEC missing, informed DO DEC Psswrd Reset UIA Usename: _____________ LACC Usename:____________ Acct. already exists Certificated need to have DEC acct. AD:in "Descript" enter "Acct. Type", "Dept"	Reactivated Psswrd Reset Expires: ______________ Groups: _________________ AD:Profile/LogonScript e76.bat Campus directory verified RightFax updated Don't pre-expire Certificated accts AD:Organization/Company is always "City"	Ext. _______ Menu # ____ Handler: _______________ Ext Recorder: ___________ Voice Mail #: ___________ Prev. User: _____________ Email: Requestor, User Form Revised: 3/9/2007